A statement released by the Center for Disease Control reports that visits to emergency deparments reached a record high of almost 144 million in 2002 even though the number of emergency departments have decreased by 14 percent from 1993 to 2003. Linda Craig of the CDC's National Center for Health Statistics explains that "emergency departments are a safety net and often the place of first resort for health care for America's poor and uninsured". The 2003 National Hospital Ambulatory Medical Care Survey Emergency Department Survey released by the CDC attributes the rise in the number of visits primarily to the increased visits by adults, especially those over the age of 66 years. The report found that Medicaid patients were four times more likely to go to an emergency room that those with private insurance. Visit rates for people between the ages of 65-74 were five times higher for those residing in a nursing home or institution than those who were not. The average waiting time to see a physician, however, did not increase from 2000. An article for MSNBC cites a U.S. Census Bureau statistic that estimates that 45 million people or 15.6 percent of Americans did not have any health insurance in 2003.

Thanks to research assistant Lindley Bain for help with this post. [tm]

Drexel Law School will be the first law school opened by a top university in the past 20 years. It is going to build on Drexel’s reputation as a technological university that offers extensive internships (which Drexel calls "co-ops"), and offer a skills-based education that teaches professionalism as well as analytic ability. It will also be different in that it will have its faculty work with the faculty of its other colleges and schools, and stress joint-degree programs. In short, its faculty will need to be both entrepreneurial and flexible.

Drexel intends to focus its upper level law curricula in three areas: health care, intellectual property, and entrepreneurial business. This responds to its core strengths in medicine, engineering/design, and business. Drexel has begun its search for candidates in those core areas, plus those who would teach the first year curriculum. To ensure its place as one of the nation’s better law schools (it aspires to be ranked in the top 50), it is looking to hire a very high quality faculty.

The goal is to have Drexel’s first hires be the leaders of the core areas, and to have them under contract by mid-September; and to have a full complement of the first-year faculty hired by January.

P.S. For more information, you can visit Drexel’s webpage: http://www.drexel.edu/law. It is still under construction, but it will give you an idea of where it is headed.

According to law.com, the new Drexel Law School just got a little bit closer to opening in the Fall of 2006 when the Board of Trustees approved its creation during a meeting earlier this month. The law school plans to have a focus in health care law. The story reports,

Drexel senior vice president and general counsel Carl "Tobey" Oxholm III said the school's next step will be to file paperwork -- as early as this week -- seeking formal approval from the state Department of Education. Oxholm said the Department of Education would make an on-campus visit and then give the school provisional approval to open its doors, hopefully with enough time for the school to begin advertising for a September 2006 start date.

Because the school would open without being accredited by the American Bar Association, Oxholm said it would offer students a discount on tuition. He said he would hope to have provisional approval before the first group of students graduate in the spring of 2009. ABA approval would also entail an on-campus visit, would require the school to meet a host of regulations and would eventually need to be approved by the House of Delegates.

Drexel officials have said its law school will distinguish itself from other local law schools by focusing its curriculum on Drexel's undergraduate and graduate academic strengths such as engineering, health care and business while incorporating the university's focus on cooperative education.

According to a UPI article in Science Daily, CBS News reports that the FDA is examining 50 cases of men who went blind after using Viagra. In 1998, Dr. Howard Pomeranz was the first doctor to make the connection between the drug and changes in vision. Since Viagra alters the blood flow in "key parts of the body," it is possible that circulation to the optic nerve could be affected. Pfizer told CBS that its studies show no reports of blindness and there is no more evidence of vision loss in men who take Viagra than those who do not. Despite these remarks, Pfizer is working with the FDA to update the label to reflect this possible side effect.

According to Reuters, reports of blindness have surfaced before, and in response, Pfizer said there was no proof that the blindness was linked to Viagra. A Pfizer spokesperson could not say how many cases had been reported. According to an article in Red Herring, Viagra has been linked to temporary changes in vision with patients reporting a tendency for the world to appear more blue or green. A study in the March issue of the Journal of Neuro-Ophthalmology reports on the eye condition nonartheritic optic neuropathy caused by Viagra. A new study shows that recreational use of Viagra is growing rapidly in men under 45 years of age.

Since we are on the subject of Viagra, CNN reports that the New York state comptroller has announced that 198 paroled rapists and sex offenders have been reimbursed for Viagra by Medicaid over the past five years. See also the NY Times Article.

Thanks to research assistant Lindley Bain for her help in preparing this post. [tm]

Anyone who has a back-list of must-reads for the summer is invited to submit to Betsy or me the titles they think will be of greatest interest to readers of this blog. An early candidate for my list, though perhaps one that will see an early exit, as well: Dean Koontz' new horror/thriller, Velocity. Here are some salient excerpts from a N.Y. Times review by Janet Maslin:

The novel's resident good guy, Billy Wiles, is bedeviled by a serial killer who tries to make Billy complicit in his violence. He forces Billy to pick the victims. And he sends Billy such high-concept threatening letters that one of them is conveniently reprinted on the book's back cover. . . . [T]his book wears its conscience on its sleeve even as it puts Billy on the receiving end of messages like this: "If you don't go to the police and get them involved, I will kill an unmarried man who won't much be missed by the world. If you do go to the police, I will kill a young mother of two. . . . "

Mr. Koontz also has blunt points to make. He underscores Billy's devotion to Barbara, his fiancée, who has been in a coma for four years, though she continues to say cryptic, beautiful things. (These are eventually explained.) Despite this sign of life, Barbara's doctor suffers a "bioethics infection" that makes him want to remove Barbara's feeding tube. "Four years is such a long time," says the doctor. "Death is longer," says steadfast Billy. Mr. Koontz also condemns scientists who work on cloning, genetic engineering and stem cell research. ("The smarter they are, the dumber they get.") He has Billy flirt with drug use to show how it can be dangerous to the soul. "Pain is a gift," he writes, after Billy discovers Vicodin. "Humanity, without pain, would know neither fear nor pity. Without fear, there could be no humility, and every man would be a monster."

Koontz has a reputation for writing thrillers with a difference. Is he up to speed with Velocity? [tm]

Sunday's Washington Post ran an interesting column by Michael Kinsley (". . . Fear of the Unknown") about the recently reported South Korean breakthrough in cloning human embryos for stem-cell research and the reactions of Leon Kass to that news. He begins:

Imagine what it's like to open the newspaper (as I did Friday morning) and read that scientists in faraway South Korea have made a huge breakthrough toward curing a disease that is slowly wrecking your life. But closer to home, your own government is trying to prevent that cure.

The reference in that lead was to Parkinson's, with which Kinsley said in December 2001 he had been diagnosed 8 years earlier. He was not pleased by Leon Kass' response to reports of the South Koreans' breakthrough:

Leon Kass, chairman of the President's Council on Bioethics, greeted this thrilling news with his usual fatuous call for a "moratorium" on the research that produced it while we think through the morality and all that. . . .

But no crash research program is going to produce some dazzling bioethical principle we never thought of before. We know all that we're going to know about the moral issues, and we just have to decide.

For Kinsley, "there are three issues," and all of them are fairly easy to dispose of:

"First, do the embryos used for stem cell research and therapy have rights?"

"Second, is human cloning such a horrific concept that it crosses a line into the territory of Frankenstein and 'Brave New World'?"

"Third, there's the slippery slope. If we're willing to destroy microscopic embryos for their stem cells, why will we stop before harvesting body parts from advanced fetuses, or breeding babies for their organs? Once we allow human cloning for embryos, how can we be sure no one will bring a cloned embryo to term and produce an actual cloned human being?"

Leif Wellington Haase has published a new book advocating reform of our health care system. He is a fan of mandatory private health insurance. The abstract for the book states,

U.S. spending on health care has grown from $246 billion in 1980 to $1.7 trillion today. At the same time, the number of uninsured Americans has increased by 5 million over the past decade. These factors, along with concern over the quality of care, have brought the need for health care reform back into the headlines. A New Deal for Health offers a plan for these much-needed reforms, one that focuses on creating large risk pools while still allowing consumer choice and maintaining high quality care.

For the further comments on his proposals, click here, here and here. [bm]

Erza Klein has an interesting post on private health insurance and discusses with some other bloggers why mandated private health insurance sometimes does not work out too well. He also posts on a health savings account that he actually likes. [bm]

For those of you who are considering a potential change in employment, the Academic Keys website provides listing of law, including law professor, job opportunities. Here are two that I thought might be of interest:

Science Daily has reported on a survey released Wednesday that says many university medical schools permit the pharmatceutical companies to influence what gets published from industry sponsored drug studies. The article expressed concern about the possible negative consequences of withholding negative study results since pharmaceutical companies fund over 70 percent of clincial drug trials. Harvard's Michelle Mello in her article in the May 26 issue of the New England Journal of Medicine (abstract) insists that the relationship between academia and the drug companies should be closely monitored. Dr. Peter Lurie of Public Citizen in Washington is concerned that correcting the problem in the academia area will only shift it to the private sector where drug companies can contract out research to privatec contract research organizations (CROs). These CROs may have even less of an incentive to publish negative results.

After two notorious recent incidents (the removal of Vioxx and the use of anti-depressants in children) there have been allegations that drug manufacturers withheld data that indicated the possibility of safety problems from academic researchers.

In her study, Mello sent 107 university medical centers questionnaires about their policies for conducting research sponsored by the drug industry. She found that 85% of medical centers said they would not allow industry sponsors to revise manuscripts for publication in journals or give them th authority to decide whether results of a study should be published. 24 percent said they permit industry sponsors to insert their own statistical analysis in manuscripts. 50 percent said they permitted industry people to draft the manuscript. 41 percent said they allowed the drug industry to prohibti investigators from sharing research results with third parties.

According to the N.Y. Times, the study reported that 69 percent of administrators surveyed said competition for research money "created pressure on adminstrators to compromise" with drug companies. Scott Lassman, assistant general counsel for Pharmaceutical Research and Manufacturers of America stated that "it's a hypothetical study and doesn't measure what these institutions routinely do or don't do." One medical center reported that a commercial sponsor refused to make the last payment for a drug trial "apparently because they did not like the results of the study."

The AP also reported on this conflict of interest. The article mentions several efforts to remedy the situation such as:

AMA working with the drug industry to eliminate gag clauses in research contracts;

American Assocation of Medical Colleges developing set of principles for researchers and sponsors of studies;

bill pending in Congress that would require public and private sponsors to register their studies in a government database;

11 members of International Committee of Medical Journal Editors promised last year not to publich any studies not registered in the database.

Thanks to my reearch assistant, Lindley Bain, for her help in preparing this post. [tm]

An article on Modernhealthcare.com reports that Sen. Chuck Grassley, chairman of the Senate Finance Committee, has asked 10 hospitals and health systems for information on their charitable activities, patient billing and partnerships with for-profit companies. This inquiry comes in advance of legislation he will propose that aims at preventing non-profit organizations from abusing their federal tax-exempt status. He complains that not-for-profits shift the most profitable practices and income streams to joint ventures to share in greater profits. In a letter included in Grassley's press release, the senator posed 46 questions to the 10 organizations, including: define charity care; specify their percentage of uninsured, Medicare, and Medicaid patients; and indicate by how much charges typically exceed costs of charity care.

POSITION ANNOUNCEMENT – FELLOW IN BIOTERRORISM LAW, POLICY, AND PUBLIC HEALTH

GEORGETOWN UNIVERSITY LAW CENTER and the Center for Law and the Public’s Health at Georgetown and Johns Hopkins Universities are seeking qualified candidates for a fellowship in bioterrorism law and policy and public health law. Full-time candidates will be based at Georgetown University Law Center and work with faculty and students at Georgetown and Johns Hopkins Universities on a two-year project. The project involves analyzing the federal framework for response to a high consequence public health event.

Candidates must have their J.D. degree, and exceptional academic credentials, including publication and strong research interests and knowledge or experience in public health law and ethics. Candidates with an M.P.H. degree or public health experience may be preferred.

Application by July 15, 2005, should be made by letter, with accompanying resume, writing sample, official law school transcripts, and public health school transcripts (if applicable).

For further information or to apply, please write, call or email: Professor Lawrence Gostin, Director, Center for Law and the Public’s Health, Georgetown University Law Center, 600 New Jersey Ave, NW, Washington, DC 20001; (202) 662-9373; gostin@law.georgetown.edu.

According to an article in the UK's Independent (subscription only), a new study reveals that, " . . .that the more committed and successful a woman is at work, the worse her partner feels." The study blames this finding on a syndrome called (and I am not making this up) "unfulfilled husband hypothesis", which makes men feel inadequate when women depart too dramatically from their traditional roles. The article does not contain much information about the study or how it was conducted but the conclusions seem rather unhelpful. I don't like it when my husband has to work late or fails to pick up the dry cleaning - perhaps I have "unfilled wife hypothesis."[bm]

Update: While not scientific, Matt Miller's editorial in the New York Times seems to provide an answer to the problems identified in the above study.

Indiana governor Mitch Daniels refused [press release] to grant clemency or a 90-day stay of execution for Gregory Scott Johnson, a convicted murderer [Indiana Supreme Court's denial of post conviction relief] who hoped to give his kidney and liver to his sister, who suffers from non-alcoholic hepatitis. In a statement released after his death Wednesday morning, Johnson accused the parole board of failing to recognize he had changed while in prison and was capable of this humane act. The governor said he would have been amenable to a short delay if Johnson's donation offered "a clear, demonstrated medical advantage to his sister." Doctors decided Johnson was not a good match because of his weight and hepatitis B diagnosis, and the doctors reasoned Johnson's sister would likely get a liver and kidney from the transplant waiting list shortly.

A Reuters story on the execution points out that death-row transplant requests have occurred, albeit rarely, before:

In a 1995 Delaware case a condemned man donated a kidney to his mother, and returned to death row. In Alabama, a prisoner awaiting execution won permission for an organ donation, but he was not a correct match, [Richard] Dieter [executive director of the Death Penalty Information Center] said.

In a Florida case, an inmate was denied a request to donate a kidney to his brother. The condemned man was later exonerated and released from jail, but his brother died waiting for a transplant, Dieter said.

A similar request by death-row prisoner Jonathan Nobles was denied by Texas prison officials in 1998 (Abilene Reporter-News). Those of us who are old enough to remember Jack Kevorkian before he became the media-saturated "Dr. Death" may recall his campaign in the 1970s and 1980s to allow death-row prisoners to donate organs that would otherwise be needed to keep them alive. [tm]

According to Professor Paul Caro of TaxProf, a new study has been completed concerning what factors are important to students when evaluating courses. The abstract for the study follows:

College students publicly rate their professors' teaching at RateMyProfessors.com, a web page where students anonymously judge their professors on Quality, Easiness, and Sexiness. Using the data from this web site, we examine the relations between Quality, Easiness, and Sexiness for 3,190 professors at 25 universities. For faculty with at least 10 student posts, the correlation between Quality and Easiness is 0.61, and the correlation between Quality and Sexiness is 0.30. Using simple linear regression, we find that about half of the variation in Quality is a function of Easiness and Sexiness. Accordingly, these results suggest that about half of the variation in student opinion survey scores used by universities for promotion, tenure, and teaching award decisions may be due to the easiness of the course and the sexiness of the professor. When grouped into sexy and non-sexy professors, the data reveal that students give sexy-rated professors higher Quality and Easiness scores. Based on these findings, universities need to rethink the use of student opinion surveys as a valid measure of teaching effectiveness. High student opinion survey scores might well be viewed with suspicion rather than reverence, since they might indicate a lack of rigor, little student learning, and grade inflation.

The full article is available here. Of course, Professor Caron notes that tax professors may be disadvantaged because their courses are not easy - has he heard of ERISA, Fraud and Abuse and HIPAA?? Anyway, I am not sure why sexiness is being rated on the RateMYProfessor.com. I don't think that anyone I know would change their teaching style or appearance if law school student evaluations suddenly did consider such a factor. Now if a study showed that teacher sexiness improves a school's U.S. News and World Report Ranking, well -- I cannot say what various administrations would do but . . . . [bm]

The N.Y. Times reported today that the House of Representatives passed two bills that would allow federal funding of embryonic stem-cell research (click for the roll call votes on H.R. 810 and H.R. 2520). This legislation will reverse President Bush's ban on using federal money to conduct embryonic stem-cell research on new (post-8/9/2001) stem-cell lines. (H.R. 2520 would promote contracts with cord-blood banks to promote stem-cell therapies. It passed by a 431-1 vote.) If H.R. 810 becomes law, embryonic stem-cells would come from live human embryos scheduled to be discarded at fertility clinics. Even though President Bush has already said he will veto this bill if necessary (see previous post), 50 House Republicans broke with him and voted with 187 Democrats. The House vote fell short of the 290 votes needed to override a presidential veto. The issue will go to the Senate where an identical bill is pending.

The Times article also states that President Bush has said that despite the potential for medical breakthrough, the use of human embryos in the studies was too high a cost to pay. According to the Washington Post, one of his supporters, House Majority Leader Tom DeLay (R-Tex.), said that the "bill would force taxpayers to finance 'the dismemberment of living, distinct human beings'." Many members -- Democrat and Republican alike -- indicated their intention to vote for both bills, saying that together they represented hope for the largest number of people with illnesses or conditions that might be treated with stem-cell therapies.

In a commentary for MSNBC, Arthur Caplan criticized President Bush's position on stem-cell research. He stated that President Bush and his supporters have made a mockery of the moral issues involved and that his policy makes little ethical sense to most Americans. He criticizes the president's moral reasoning as inconsistent, since he claims embryo destruction is wrong but still would permit research on embryos destroyed before August 2001 and has done nothing to prevent the daily destruction of embryos in fertility clinics. Rep. Mike Castle (R-Del.) is a proponent of the stem cell research bills and has collected a lot of commentary on the issue on his "Stem Cell Research and Resource" page. [tm]

I don't think we've remarked upon an otherwise remarkable series about the practice of medicine that appears from time to time in the Wall Street Journal. The pieces occasionally display some of the editorial bias of that newspaper, as in today's installment, with its commentary on the increasing unavailability of obstetrical services in a rural county in Illinois (quietly described as having relatively high malpractice insurance costs). But mostly they are nicely drawn snapshots of medical practice in these here United States. Here's a list of the titles since November:

05/24/05 When a Doctor Departs or Dies

05/10/05 Waiting Isn't Good for Patients, or Profits

04/26/05 How Mistakes Happen in the Doctor's Office

04/12/05 A Father's Character, and Cancer, Influence a Career

03/31/05 A Doctor's Struggles at End-of-Life

03/15/05 Plan May Hurt a Patient, and Taxpayers

03/01/05 When a Baby Doesn't Make It

02/15/05 The Doctor Is In, 24/7

02/01/05 Payoffs of a Patient-Friendly Office

01/18/05 Hospitals Can Improve Quality and Safety

01/04/05 When a Pregnant Patient Struggles to Find Care

12/21/04 The Doctor's Antidepressant Dilemma

12/07/04 Even Adults Need a Spoonful of Sugar

11/23/04 Helping Patients in a Post-Vioxx World

Of course, there's a catch: The electronic version of the Wall Street Journal requires a paid subscription, and it ain't cheap. [tm]

As was noted in this space on May 4, the Associated Press has reported that government-funded researchers have tested AIDS drugs on hundreds of foster children over the past two decades without providing a guardian. The foster children received medical care from world-class researchers, which slowed their death rate and extended their lives, but it also exposed them to significant risks. Even though the government was supposed to appoint independent advocates as of 1983, most research institutions promised but did not provide advocates. Some foster children died during the studies, but no agency can find any record that any death was directly caused by experimental treatments.

In an op-ed piece in the Toledo Blade, Dr. Mark Kline, professor of pediatrics at Baylor College of Medicine and director of the Baylor International Pediatric AIDS Initiative, responded to an editorial in the Blade that criticized researchers who enrolled foster children with HIV in studies of anti-AIDS drugs without appointing an outside advocate for these children. He wrote that foster children were not singled out but included with other children in the same research. He insisted that the decision to use foster children for research was in part due to the deadliness of AIDS for children during that time since available treatments offered only partial, short-lived benefits. Many of the potent drugs approved for adults in the mid-1990s were not approved for children because no pediatric studies had been done. He stated that researchers did not provide advocates because the treatments could potentially be beneficial and foster children were being put at no more risk than other children in the same situation.

A DHHS official recently stated that "current regulations are adequate to ensure that foster children enlisted in federal medical experiments are protected" (Washington Post).

Thanks to research assistant Lindley Bain for her help with this post. [tm]

The House of Representatives is set to vote on the Castle-DeGette bill permitting funding for research on stem cells from embryos created at fertility clinics that would not otherwise be used. They will also vote on a separate bill, supported by many pro-life representatives, which encourages research on stem cells drawn from umbilical cord blood. Supporters are predicting passage of both bills.

The NewsHour ran a short piece last nice discussing the various political aspects of the stem cell research and the two bills. [bm]

Monday's LA Times has an excellent article discussing the trends, specifically the new popularity of health savings accounts, in health care. The article reports,

For years, they were the kinds of health insurance plans one found at small businesses or among the self-employed, plans that had huge deductibles and required workers to pay a lot of medical bills themselves — such as allergy shots, chest X-rays and the cost of a new baby.

They weren't the policies most people preferred, but they were the best some people could afford, better than no insurance at all.

Now, as medical costs keep climbing, those high-deductible plans are spreading to the giant corporations that have long been the backbone of traditional job-related, low-deductible health insurance. And if the trend continues, it could reshape the medical insurance landscape and sharply redistribute costs, risks and responsibilities for many of the 160 million Americans with private coverage.